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# Cefriaxone
## Overview
Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic. It is administered via intramuscular (IM) or intravenous (IV) injection.
## Primary Indications
* Pneumonia
* Meningitis
* Skin and soft tissue infections
* Urinary tract infections
* Bone and joint infections
* Gonorrhea
* Disseminated Lyme disease
* Surgical prophylaxis
## Adult Dosing
* **General infections:** 1 to 2 grams (g) IV or IM every 12 to 24 hours.
* **Severe infections:** Up to 4 g IV per day, divided every 12 hours.
* **Meningitis:** 2 g IV every 12 hours.
* **Surgical prophylaxis:** 1 to 2 g IV or IM 30 to 120 minutes before incision.
* **Gonorrhea:** 500 mg IM (1 g for disseminated gonococcal infections).
## Pediatric Dosing
* **Neonates (0-14 days):** 25 to 50 mg/kg IV or IM once daily. Do not exceed 50 mg/kg/day. Do not use in hyperbilirubinemic neonates.
* **Neonates (15-28 days):** 50 mg/kg IV or IM once daily.
* **Children older than 28 days:** 50 to 100 mg/kg IV or IM once daily, or divided every 12 hours.
* **Meningitis (children > 28 days):** 80 to 100 mg/kg/day IV, divided every 12 to 24 hours. Maximum dose 4 g/day.
Dosing may vary based on infection type and severity, as per institutional guidelines.
## Dose Adjustments
No dose adjustment is typically needed for hepatic impairment.
For renal impairment, if the creatinine clearance (CrCl) is less than 10 mL/min, the usual dose should not exceed 2 g every 24 hours. If both hepatic and renal function are impaired, monitor ceftriaxone plasma concentrations.
## Contraindications
* Known hypersensitivity to ceftriaxone, other cephalosporins, penicillins, or other beta-lactam antibiotics.
* Neonates (≤ 28 days) receiving IV calcium-containing solutions or infusions.
## Adverse Effects
Common: Diarrhea, rash, phlebitis, eosinophilia, thrombocytosis, leukopenia.
Serious: Anaphylaxis, Clostridioides difficile-associated diarrhea, biliary sludge or pseudolithiasis, renal injury, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Aminoglycosides:** Increased risk of nephrotoxicity, especially in neonates.
* **Probenecid:** May increase and prolong ceftriaxone serum levels.
* **Oral contraceptives:** May decrease efficacy.
* **Calcium-containing solutions:** Contraindicated in neonates. Avoid concurrent administration in adults via separate IV lines. If coadministration is necessary, flush lines thoroughly between administrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea; assess for C. difficile.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Consider monitoring drug levels in neonates or patients with severe renal/hepatic impairment.
## Clinical Pearls
* Ceftriaxone is often a drug of choice for community-acquired pneumonia and meningitis.
* Its long half-life allows for once or twice-daily dosing.
* IM administration may be painful; consider lidocaine as a diluent if recommended by local protocol.
* Do not mix or administer ceftriaxone concurrently with calcium-containing solutions.
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*Disclaimer: This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current prescribing information and institutional guidelines for definitive patient care decisions.*
